Surveying the Damage: A Review of Research on Consequences of Alcohol Misuse
in College Populations

H. WESLEY PERKINS, Ph.D.Department of Anthropology and Sociology, Hobart and William Smith Colleges,
Geneva, New York 14456

ABSTRACT. This article provides a review and synthesis of professional
research literature on the types, extent and patterns of negative
consequences produced by student's misuse of alcohol in college populations
based on survey research conducted during the last two decades.
Considerable evidence is available documenting a wide range of damage
by some student's drinking done to themselves as well as to other
individuals, although some types of consequences remain speculative.
Damage and costs to institutions are likely to be substantial, but this
claim remains largely an inference based on current studies. Drinking
by males compared with that of females produces more consequences
for self and others that involve public deviance, whereas female's drinking
contributes equally with males to consequences that are personal
and relatively private. Research on racial/ethnic background, time trends
and developmental stages reveals patterns in student data on consequences
of drinking, but these data are very limited in the literature.
Evidence suggests there is only a modest correlation between student's
self-perception of having a drinking problem and the many negative consequences
of drinking that are reported. (J. Stud. Alcohol, Supplement
No. 14: 91-100, 2002)

ALCOHOL IS routinely cited by researchers, college administrators and staff,
and also by students themselves, as the most pervasively misused substance on
college campuses. Anecdotal evidence and dramatic examples of negative consequences
of college student drinking are readily found in counseling and hospital records
and police reports as well as in the simple observation of property damage and
litter following many campus social events. Questions remain, however, about
the actual patterns and pervasiveness of student alcohol misuse. What is the
range and extent of negative consequences found in student populations? Are
problems broadly experienced or are they concentrated primarily in certain individuals
who tend to suffer many consequences, and what are the consequences for academic
institutions? This article provides a review and synthesis of the existing professional
research literature addressing these questions about the types and extent of
negative consequences, what can be concluded about their distribution from consistent
findings, what is more speculative based on limited research and what is still
unknown due to the lack of research. A review of all the causal factors contributing
to drinking problems on college campuses, however, is a task beyond the scope
of this article.

This review of damage due to collegiate alcohol misuse
draws most evidence from anonymous student surveys conducted
and published within the last two decades. Some
studies have collected large nationwide databases, thus
providing the greatest generalizability. Studies based on data
collected at individual colleges and universities are also
included, demonstrating variation and similarity in certain
types of consequences across regions and institutional contexts.
Studies of single institutions also provide assessments
of additional consequences or different measures of consequences
that broaden the assessment of damage. Both the
national and local studies report the prevalence of problems
at varying historical moments and with measures spanning
a variety of time frames (e.g., within the last week,
within the academic year or over one's lifetime).

Finally, it is important to note that some studies provide
prevalence rates among the entire student population
whereas other studies report the prevalence of consequences
only among drinkers. Both rates provide important information
about negative consequences. The former provides
a general measure of pervasiveness and the latter a risk
measure indicating how likely it is that a student's drinking
is going to result in a particular type of problem. Thus,
where possible, based on the data provided in the published
study, rates for drinkers are calculated and included
in this review along with published rates of the entire student
sample. Likewise, rates for the entire sample are calculated
and included here along with published rates for
drinkers only.

Types of Consequences

In surveying the collegiate damage that may accumulate
from student alcohol misuse, it is useful first to divide the
broad terrain of problems into categories depending on the
object (self, others, institutions) and nature of the consequences.
Table 1 presents the different foci used in cataloging
the range of consequences in the college environment.

Damage to self

Risky drinking behavior may be the cause or important
contributing factor in many different academic, emotional,
physical, social and legal problems experienced by undergraduates.
Indeed, the picture of extensive harm to at least
a significant minority of students on most campuses is
clearly supported by the research.

Academic impairment. A substantial amount of empirical
research is available demonstrating a connection between
alcohol consumption and impaired academic
performance. Among 41,581 students responding to the Core
Alcohol and Drug Survey in representative mail and classroom
administrations at 89 institutions holding FIPSE drug
prevention program grants nationwide in 1992-94, 22% indicated
that they had performed poorly on a test or project
(26% of drinkers), and 28% had missed a class during the
last year (33% or one-third of drinkers) due to alcohol or
other drug use (Presley et al., 1996). Wechsler et al.'s (1998)
nationwide College Alcohol Study surveyed a nationally
representative sample of 14,521 students attending 116 fouryear
colleges and universities in 1997 and found that 24%
(30% of drinkers) reported missing a class within the current
academic year as a result of drinking and 19% (23%
of drinkers) reported getting behind in schoolwork during
the current year as a result of drinking. Males drinking 5+
drinks or females drinking 4+ drinks in a row one or two
times in a 2-week period were more than three times as
likely to report getting behind in schoolwork due to their
drinking in the current year in comparison with more moderate
drinkers, and males drinking 5+ or females drinking
4+ drinks in a row on at least three occasions in a 2-week
period were more than eight times more likely to report
this problem.

Similarly, Engs et al.'s (1996) Student Alcohol Questionnaire
administered to 12,081 students who were contacted
in a demographically representative quota sample of
168 four-year institutions across the United States in 1994
revealed higher levels of consumption associated with markedly
higher rates of alcohol-related academic problems.
Among “low-risk drinkers” (males consuming 21 or fewer
drinks and females consuming 14 or fewer drinks per week),
11% had missed class due to a hangover, and less than 3%
noted having received a lower grade due to drinking. Among
“high-risk” drinkers (22+ drinks/week for males and 15+
drinks/week for females), however, more than half of these
survey respondents had missed classes due to a hangover,
and more than 15% reported receiving a lower grade due
to their drinking.

High rates of drinking-related academic problems can
be found in demographically diverse campus settings. For
example, Werch et al. (1987) found that 18% of a sample
of 410 students (23% of drinkers in the sample) attending a
midsize southern university admitted they had missed class
due to a hangover in the past year. Perkins (1992) found
one-third of students reporting they had missed classes or
examinations or had performed poorly on assignments due
to their drinking during the academic year in a sample of
584 students from a small, private college with few abstainers
in the Northeast.

In addition to students' subjective determinations of academic impairment,
a consistent association between self-reported grade averages and levels of
alcohol consumption is revealed in several studies. For example, among Core
Survey respondents nationally (Presley et al., 1996), A average students consumed
an average of 3.4 drinks per week, B average students were drinking 4.5 drinks,
C students were drinking 6.1 drinks, and D or F students typically drank 9.8
drinks. This pattern was found at 2-year schools as well as 4-year institutions.
Likewise, Engs et al. (1996) reported a consistent inverse relationship between
weekly drink averages and grade point average in their national study. Of course,
correlation does not prove causality here. Although quite plausible, it cannot
be determined with certainty from these cross-sectional data that heavier drinking
per se was responsible for the lower grade performances. Wood et al. (1997)
provided this caution based on their study of 444 students attending a large
midwestern university. Although they also found a bivariate association between
problematic alcohol use and academic problems, most of the association was accounted
for by controlling for family background factors and student academic characteristics
that existed before any collegiate drinking.

Blackouts. The phenomenon of alcohol-induced “blackouts”;
or memory loss during periods of heavy drinking is a
common consequence found among alcoholics but has also
been found in other populations of drinkers as well. It is
not always clear whether such reports include partial forgetting,
or perhaps mistaking blackout if undefined as passing
out (Buelow and Koeppel, 1995). Nevertheless, in the
nationwide College Alcohol Survey (Wechsler et al., 1998),
22% of students (27% of drinkers) reported at least one
incident of having forgotten where they were or what they
did due to drinking in the past year. Similarly, 26% of
respondents (31% of respondents who drank) in the Core
Survey indicated that they had “had a memory loss” due to
drinking or other drug use in the past year (Presley et al.,
1996). Upward to almost half of all students in several
studies of regionally diverse single institutions reported having
had such experiences within their lifetime (Buelow and
Koppel, 1995; Sarvela et al., 1988; Werner et al., 1993).
Meilman et al. (1990) found 4.4% of students reporting a
blackout within the last week in a random sample attending
a private university in rural New England.

Personal injuries. Injuries to oneself as a result of one's
drinking are not an uncommon consequence. The College
Alcohol Study found 9% of students (12% of drinkers) in
this category within a 1-year period nationwide (Wechsler
et al., 1998), and the Core Survey (Presley et al., 1996)
revealed 13% (15% of drinkers) reporting injury to self as
a consequence of alcohol or other drug use within the year.
Perkins (1992) found one of five students having experienced
this consequence within the academic year at a private
northeastern college where more than 95% of students
drank alcohol.

Physical illnesses. Short-term health-related consequences
of heavy drinking such as hangovers, nausea and vomiting
are experienced by a large minority, if not the majority, of
students on most campuses. The Core Survey of students at
89 schools across the nation produced a self-report result
of 40% with at least one hangover (47% of drinkers) and
47% (56% of drinkers) having nausea or vomiting as a
result of alcohol or other drug use within the year (Presley
et al., 1996). In one study at a New England university
where almost all students (97%) drank alcohol within the
year, however, 29% of the student sample reported that
anywhere from .5 to 24 hours of their normal functioning
were lost “in recovery” from drinking in the last week
(Meilman et al., 1990). Alcohol poisoning as a result of
excessive consumption and occasional fatalities that result
from these extremely high blood alcohol levels are not unfamiliar
incidents in campus health centers and local hospital
emergency rooms. However, evidence of these tragic
consequences is found only in news headlines and anecdotal
reports. Systematically collected data on the prevalence
of student alcohol poisoning are not available in the
research literature.

Longer term consequences of heavy alcohol use to one's health may include reduced
resistance to illnesses. Self-reported illnesses were correlated with drinks
consumed per week among undergraduates enrolled in a general education course
at a large midwestern university (Engs and Aldo- Benson, 1995). Although light
to moderate consumption was not significantly associated with increased health
risks, consuming an average of 22 drinks or more per week was associated with
increased upper respiratory infections, and consuming 28 drinks or more was
associated with greater acute illness on an aggregate measure, thus suggesting
that heavy alcohol consumption contributes to lowered resistance to common illnesses
among students. Of course, social background correlates of health care and drinking
behavior may contribute to this association.

Unintended and unprotected sexual activity. In recent
years, research has considered the potentially increased risk
of engaging in sexual activity unintentionally as well as the
increased risk of not using protection against pregnancy or
sexually transmitted diseases. A variety of measures assessing
the incidence of these different but related consequences
(unintended and unprotected sexual relations) have
been employed in student surveys. At a college in New
York, Perkins (1992) found that one-quarter of the students
reported engaging in either unintended or unprotected sexual
activity at least once as a result of drinking during the academic
year, with 15% of males and 10% of females reporting
multiple occurrences. Wechsler and Isaac (1992) found
that heavy episodic drinkers in Massachusetts colleges were
about three times as likely as other drinkers to engage in
unplanned sexual activity. Meilman (1993) found that one
in five undergraduates at a southeastern college acknowledged
having participated in sexual intercourse as a result
of being under the influence of alcohol since coming to
college, and 17% of undergraduates had abandoned safesex
techniques under the influence of alcohol (9% had done
so on more than one occasion). In the 1997 College Alcohol
Survey (Wechsler et al., 1998), 18% of this sample
(23% of drinkers) had engaged in unplanned sexual activity
during the academic year, and 9% (11% of drinkers)
reported not using protection due to their drinking.

Among students sampled at 12 universities across the
United States, Anderson and Mathieu (1996) found that, of
those who had one or more sexual partners in the last year,
33% of the men and 17% of the women had let themselves
drink “more than normal” at least once as a disinhibitor to
make sex easier. In those circumstances, one-quarter of the
sample did not initiate condom use. In another study, using
a convenience sample of 210 participants from a large southeastern
university, more than one-third of respondents reported
drinking to enhance sexual experiences, and twothirds
noted that their drinking had at some time had a
negative consequence for them sexually (Poulson et al.,
1998). In the same study, 70% of all students reported that
they were less likely to use a condom in sexual activity
after they had been drinking. Research at another southeastern
university showed that for both men and women
the frequency and quantity of usual alcohol consumption
as well as having consumed alcohol prior to the last occurrence
of sexual activity were positively associated with having
multiple sexual partners (Desiderato and Crawford,
1995). Condom use did not demonstrate a consistent pattern
in relation to alcohol use, however, in this research.

Suicide. Although links between suicide and substance
abuse can be found in the research and clinical literature of
psychopathologies, there are very little empirical data to
draw on from the studies of broad college populations. Although
most reports are anecdotal, some systematic survey
evidence of the potential for alcohol misuse to result in this
extreme consequence is suggested by national Core Survey
data (Presley et al., 1996). Specifically, 5.1% of respondents
(6.1% of drinkers) confided that they had suicidal
thoughts, and 1.6% (1.9% of drinkers) revealed that they
had actually tried to commit suicide within the last year
due to drinking or other drug use. It must be noted, of
course, that the measure used is a self-perceived assessment
of the causal order. It is certainly plausible that suicidal
thoughts may lead to elevated drinking, as depression
increases the propensity to drink heavily.

Sexual coercion and acquaintance rape victimization.
The prevalence of sexual coercion and rape victimization
among female undergraduates has received significant documentation
in empirical research (see Koss et al., 1987).
Much of this victimization experience has been linked to
the victim's alcohol use (as well as to the perpetrator's
consumption). Of those participating in the Core Survey
nationwide (Presley et al., 1996), 12% of females (14% of
female drinkers) reported having been taken advantage of
sexually during the last year as a result of their drinking or
other drug use. It is surprising to note that 11% of males
(13% of male drinkers) also indicated this experience, given
that most of the research has focused on female
victimization.

Frintner and Rubinson (1993) found that 27% of a random
sample of female undergraduates at a midwestern university
were victims of sexual assault, attempted sexual
assault, sexual abuse or at least one incidence of battery,
intimidation or illegal restraint. Of women who were victims,
55% had been drinking at the time. Among drinking
women who had experienced sexual assault or attempted
sexual assault, 60% reported their judgment had been moderately
or severely impaired at the time due to drinking.
Similarly, Harrington and Leitenberg's (1994) research on
1,090 female undergraduates attending four New England
universities revealed that 25% had been victims of sexual
aggression by an acquaintance since age 16 and more than
half of the victims were at least somewhat drunk when
victimized. In a study of 1,025 single white female students
between the ages of 17 and 23 at another large
midwestern university, higher scores on a global measure
of experiencing sexually coercive behaviors were linked to
heavy drinking (Gross and Billingham, 1998).

Explanations for the association between female students'
drinking and increased risk of sexual victimization most
often point to (1) increased consensual sexual activity prior
to the forced activity, as alcohol contributes to more casual
sexual behavior that may be misinterpreted by the male as
an invitation to further sexual contact; (2) the cultural stereotype
of a drinking woman as “loose” and therefore more
desirous of sexual contact; (3) the victim's diminished ability
to communicate clearly her choice to reject sexual advances
when she is intoxicated; and (4) the diminished ability of
the victim to defend herself physically or flee from an aggressor.
(Abbey and colleagues [Abbey, 1991; Abbey et
al., 1996] provide a more in-depth review and theoretical
analysis.) These explanations should not be interpreted as
“blaming the victim.” Rather, the point here as in the studies
cited is that, regardless of the fact that the woman should
always have the right to reject or limit sexual advances at
any point in any intimate encounter, increased alcohol consumption
substantially reduces her ability to avoid being
victimized.

Impaired driving. For students who have access to cars, impaired driving
performance may be another negative consequence of their collegiate drinking.
National survey data reveal approximately one-third driving under the influence
of alcohol during the academic year (Presley et al., 1996; Wechsler et al.,
1998). According to Engs et al. (1996), 17% of males and 10% of females who
were light-to-moderate weekly drinkers reported having driven while drunk at
least once during the year, whereas 56% of males and 43% of females who were
relatively heavy weekly drinkers reported having done so.

Legal repercussions. Alcohol misuse occasionally results
in disciplinary action against students or in arrests and prosecutions
for violation of liquor laws such as minimum age
requirements, open container restrictions, public intoxication
or driving while alcohol impaired. In nationwide survey
data, findings range from 5% to 12% of students
admitting trouble with police or campus authorities as a
result of their alcohol use (Engs and Hanson, 1994; Presley
et al., 1996; Wechsler et al., 1998). Student arrests for driving
while intoxicated were reported at a rate of 1.7% (2.0%
of all drinkers) in the Core Survey (Presley et al., 1996).

Impaired athletic performance. Many other personal consequences
appear likely due to misuse of alcohol by various
types of students, but systematic empirical research is
lacking. Using national Core Survey data, Leichliter et al.
(1998) have shown that athletic team members and, even
more so, team leaders consume more alcohol per week than
nonathletes. These athletes were more likely to consume in
a heavy episodic fashion and generally incurred more negative
consequences as a result. There are no data in the research
literature on student athletes, however, that specifically
assess impaired athletic performance due to their
drinking. It can only be inferred that there is significant
performance loss, given relatively high consumption levels
each week by some athletes that could be detrimental to
their physical capacities.

Damage to other people

While the research reviewed above makes clear the broad
extent of damage that some students inflict on themselves
as a result of their drinking, many consequences of student
drinking are simultaneously or specifically inflicted on other
people. Residents of local neighborhoods and campus
visitors as well as college student, faculty and staff members
may suffer as a result of individual students' heavy
drinking.

Property damage and vandalism. Damage to neighborhood
or residence hall personal space of others and the
unsightly residue of intoxication, such as vomit and litter,
are common complaints in the aftermath of student parties
where alcohol is conspicuous. A consistent 8% of students
admit damaging property or pulling a fire alarm in connection
with their drinking during the year in several nationwide
surveys conducted throughout the 1990s (Engs and
Hanson, 1994; Presley et al., 1996; Wechsler et al., 1998).
In Engs et al.'s (1996) national study, 6% of males and 2%
of females who were “low-risk” in the amount they drank
committed property damage in the last year, whereas 33%
of males and 13% of females who drank at “high-risk”
levels did so. Wechsler et al. (1995b) reported 12% of students
claiming to have sustained property damage due to
other students' drinking.

Fights and interpersonal violence. The interconnections
of alcohol use to aggression and pathological behavior in
late adolescent/young adult development in college have
been discussed at length elsewhere (see Pezza and Bellotti,
1995; Rivinus and Larimer, 1993). Unfortunately, measures
of violence used in studies of college populations frequently
combine acts of verbal and physical aggression under the
label of fighting even though the former may be more pervasive
in college contexts. Nevertheless, 30% of all students
(35% of drinkers) in the Core Survey nationally
reported being involved in an argument or fighting as a
result of their drinking or other drug use in the last year
(Presley et al., 1996), and 14% of students (17% of drinkers)
in another national study indicated having gotten into
a fight after drinking in the last year (Engs and Hanson,
1994). Although the drinker reporting these incidents presumably
experiences this fighting in most instances as a
personal negative consequence, others are obviously the target
of this aggression and thus experience the negative consequences
of this student's intoxication as well, regardless
of whether these other people had been drinking too. Indeed,
13% of students in one national survey stated that, as
the result of another student's drinking during the academic
year, they had been pushed, hit or assaulted; 22% stated
they had experienced a serious quarrel; and 27% had been
insulted or humiliated (Wechsler et al., 1995b).

Sexual violence. Drinking can also contribute to the violence
and damage others experience as victims of sexual
aggression. As an intoxicated student's inhibitions against
inappropriate behavior are reduced or as one's cognitive
ability to accurately perceive messages discouraging sexual
advances is dulled, the likelihood of committing rape or
some other unwanted sexual contact is significantly increased.
Abbey et al. (1998) found that, among men attending
a commuter university, greater alcohol consumption
increased misperceptions of a woman's sexual intentions,
which, in turn, produced a greater likelihood of sexual
assault.

Presley et al. (1996) found 10% of all males (12% of male drinkers) and 3%
of all females (4% of female drinkers) acknowledging that within the last year
they had “taken advantage of someone sexually“ as a result of their
own drinking or other drug use. In another national study, 21% of students surveyed
had experienced an unwanted sexual advance due to another student's drinking
within the school year (Wechsler et al., 1995b). For female victims of sexual
violence from male acquaintances at a midwestern university (27% of a random
sample of female undergraduates), 68% of their perpetrators were reported to
have been drinkingand in the judgment of the victims, almost all of these
men were impaired to some degree (Frintner and Rubinson, 1993).

Other potential disturbances. A variety of other disturbances
due to heavy drinking and intoxication are frequently
noted in news reports and anecdotal accounts of college
life, although reliable research on prevalence is slim or nonexistent.
Hate-related incidents such as harassment due to
one's race, religion or sexual orientation may be more likely
to emerge when potential perpetrators are intoxicated, but
this phenomenon has not been adequately researched. Noise
disruptions generated by student drinking on campus are
likely to affect the quality of other students' lives. Nationally,
43% of students noted they experienced interruptions
in study or sleep because of someone's drinking within the
academic year, and 44% reported having had to “babysit”
another student who had drunk too much at least once
(Wechsler et al., 1995b).

Institutional costs and damage

Student drinking can also deleteriously affect the institutional
well-being of colleges and universities. Property
damage reported by students due to drinking (cited above)
certainly includes campus property that is vandalized or
destroyed by intoxicated students in residence halls and public
restrooms or at campus concerts and athletic events,
much of which will be a cost to the institution as a whole.
Accurate research on these consequences is not available,
but more than one-quarter of campus administrators surveyed
at schools with relatively low drinking levels and
more than half of administrators at schools with high drinking
levels have reported “moderate” or “major” problems
with damage to campus property (Wechsler et al., 1995b).

Given the prevalence of academic impairment previously
cited as individual damage to self, one can extrapolate that
alcohol misuse may contribute significantly to failure and
dropout rates. This becomes an institutional cost as attrition
rates and lost tuition revenue increase. The concomitant
decrease in actual and perceived academic rigor due to
heavy drinking may exact a further cost on the institution
because much research suggests that the perceived academic
rigor of a school is the most important factor in a student's
choice of a school to attend. Strains in ‘town/gown” relations
over student alcohol misuse may add to the institution's
“image problem.”

Other institutional costs might include added time demands
and stress placed on college personnel who are required
to deal with student alcohol misuse. Although
detailed studies of lost time and emotional tolls are yet to
be conducted, it is certainly the case that much of the counseling
load in college counseling centers, calls for security
staff assistance and administrative hearings on academic
and disciplinary cases involve student alcohol misuse. In
addition, the time and emotional energy that college administrators
must devote to students and families when a
student overdoses from drinking and is hospitalized or dies
from alcohol poisoning or other alcohol-related incidents
can be enormous. Finally, the legal costs of suits brought
against academic institutions for liability in these circumstances
present another major consequence that goes well
beyond the scope of this review.

Patterns of Damage

Gender differences

Most research on negative consequences has typically
found more total consequences of student drinking for males
compared with females (Berkowitz and Perkins, 1987). Explaining
gender differences in consequences of drinking is
more complicated than simply pointing to commonly observed
discrepancies between consumption levels of men
and women. Gender differences in amounts consumed do
not translate directly into the equivalent differences in intoxication
levels because women can typically achieve the
same blood alcohol concentration as men while consuming
less alcohol due to biological differences in body weight,
fat-to-water ratios and metabolic processing. Thus one nationwide
study of students found that women who drank
four drinks in a row were about as likely to experience
negative consequences as men who drank five drinks in a
row (Wechsler et al., 1995a).

Furthermore, Perkins (1992) has argued that gender differences
in overall negative consequences have historically
been overestimated based on most research that has not
adequately taken into account types of consequences that
commonly affect female students who drink. Public risk
taking, aggression and deviance are much more culturally
ingrained characteristics of the male gender role. Male students
do, indeed, exhibit far more problems in public circumstances
and in damage caused to other people as a result
of their drinking. When damage to self and more private
consequences are considered, however, this gender gap diminishes
or even disappears. In a random sample of undergraduates
at a college in New York, Perkins (1992) found
that males were more than three times as likely to have
damaged property and twice as likely to have physically
injured others during the academic year as a result of drinking
when compared with females. In contrast, only slight
gender differences were found for the detrimental effect of
drinking on poor academic performance and unintended
sexual activity in this study, and there was no difference at
all when memory loss and injury to self were considered.
This pattern can also be found in Wechsler and Isaac's
(1992) data from Massachusetts colleges. Men were two to
three times as likely to commit property damage, get into
fights and get into trouble with police due to drinking, but
memory loss, poor academic performance and unplanned
sexual activity showed virtually no gender differences when
students were grouped by amounts consumed. Similarly,
Lo's (1996) surveys of students at a midwestern university
and a southern university and Cronin and Ballenger's (1991)
study of American students attending college in West Germany
revealed sizable gender differences in consequences
from drinking when deviant public behavior was involved,
but no significant differences in consequences to personal
health such as blackouts, vomiting, hangovers, nausea and
unintended sexual activity.

Racial and ethnic differences

Although studies exist showing heavier consumption patterns among white students
in comparison with blacks and other racial and ethnic groups (for a review of
this literature, see Prendergast, 1994), differences in actual consequences
(both in consequences overall and in particular types) have not been equally
documented. Data are available on racial/ethnic differences for a range of consequences,
however, in the nationwide Core Survey (Presley et al., 1996) database. Native
Americans and whites stand out as most problematic on almost all of the 19 items
presented. Hispanic students come next in prevalence rates of consequences matching
that of whites on a few items. Asians and blacks exhibit the least problematic
rates of consequences across all items. Thus it appears from these data that
students' consequence rates from drinking closely follow the racial/ethnic patterns
that have been reported in previous literature on consumption levels, regardless
of the type of consequence. Moreover, one can adjust for racial/ethnic differences
in abstinence rates by computing the negative consequence rates only for drinkers
and still the same overall pattern among groups remains, albeit slightly less
pronounced.

Time trends

Only a few studies document historical patterns in consequence
levels over the last generation of college students.
A report by Hanson and Engs (1992) provided nationwide
data drawn in four comparable samples at 3-year intervals
between 1982 and 1991. Significant and consistent decreases
across the time period were noted on 3 of the 17 consequence
items (where students were asked to note if the
consequence had happened at least once in the previous
year), all relating to drinking and driving. In contrast, three
items showed a significant and consistent increase in consequences:
experiencing a hangover, vomiting as a result
of drinking and getting into a fight after drinking.

Wechsler et al. (1998) provided a comparison of consequences
reported in 1993 and 1997 nationwide surveys of
college students. Significantly higher percentages were
found in all of the 12 consequence items in 1997, with the
rate of increases ranging from 10% to 50%. This picture of
increase in consequences must be tempered somewhat, however,
in that absolute differences between time periods
ranged from 0.2% to 4.5%, and statistical significance was
easily achieved with these small differences given sample
sizes of more than 11,000 in each sample. Furthermore, the
percentages experiencing negative consequences here were
for drinkers only, but the abstainer rate moved from 16%
in 1993 to 19% in 1997 (a 22% increase), so the overall
increases in negative consequences would be less for the
total population of students.

Finally, Perkins' (1992) study of gender differences in
consequences provided data that, although collected in only
one undergraduate institution, are based on four representative
samples collected across a 10-year period from 1979
to 1989. In six of the eight consequence types considered,
there was no evidence of consistent change in the gender
patterns. That is, where males were more highly represented
on consequences, they tended to remain so across time,
and where little or no difference existed between men and
women in the earlier years, this remained the case as well.
With regard to physical injury to others, however, the very
large differences between men and women declined, and
with regard to physical injury to self, the gender difference
observed in the earlier years disappeared completely by
1989.

Frequency of consequences for individuals

Only a few studies cited in this review include any information
about the frequency with which specific consequences
occur for individuals. Presley et al. (1996) recorded
six categories of response (never, once, twice, 3 to 5 times,
6 to 9 times and 10 or more times within the year) for
consequences. Being hurt or injured, getting in trouble with
the police and performing poorly on a test, if experienced
at all, occurred only once or twice for most individuals that
experienced them. For hangovers, driving a car under the
influence and missing class, however, occurrences of 3 to
5 times within the year were just as frequent as reports of
only two occurrences. These findings might suggest that
although certain drinking outcomes may be viewed as negative
by researchers, they may not be perceived or experienced
as such by some students.

Developmental and contextual effects

The prevalence, amount and frequency of alcohol consumption
typically increase in the transition from high
school to college and typically decrease after graduation.
This pattern may be indicative, in part, of developmental
transitions from adolescence into early adulthood. Changing
social contexts in late adolescence with greater access
to alcohol and legal drinking age peers and the nature of
the transition into and out of college environments may
also play a role. Nationwide data comparing traditional age
college students and their noncollege counterparts reveal
notably higher rates of heavy episodic drinking (consuming
five or more drinks in a row) among the college students
(Johnston et al., 1997). This suggests that the culture
of heavy alcohol use in peer-intensive campus contexts is a
crucial factor for young adults. Analyses examining negative
consequences of drinking across transition points are
unfortunately very rare, however, and no comparisons of
negative consequence rates between college and noncollege
young adults were found in the body of research under
review here. Nevertheless, a few studies reporting consequence
measures across collegiate stages can be cited. Using
an index of total negative consequences from drinking,
Curtis et al. (1990) found no significant differences between
first-year students and seniors at a midsized eastern
college (large gender and ethnic differences were revealed
on the measure of consequences, however). Presley et al.
(1996) uncovered very few differences in rates across the
cross-section of undergraduate class years. First-year students
were less likely to have experienced a hangover during
the year (55%) compared with seniors (65%). First-year
students and sophomores were more likely to have gotten
into trouble with police or campus authorities (15% of each
year) in comparison with seniors (9%). Driving while intoxicated
steadily increased across class years from 28% to
38%. Being hurt or injured due to drinking during the year
steadily declined from 15% to 11%. Having been taken
advantage of sexually steadily declined from 14% to 10%.
Among all the other negative consequences of drinking that
were surveyed—poor academic work, missed class, property
damage, arguments and fights, nausea and vomiting,
memory loss, arrests for driving while intoxicated and suicidal
thoughts and attempts—there were no appreciable patterns
of difference across class years.

Perkins (1999) examined college to postcollege transitions
in drinking behavior and motivations that included
measures on a wide range of negative consequences. Graduate
cohorts surveyed as undergraduates were again surveyed
from 2 to 13 years since graduation about the same negative
consequences. This study demonstrated sharp drops in
single and multiple negative consequence rates in the first
few years after graduation followed by continuing declines
in these consequence rates in subsequent postcollegiate
years.

Perceptions of self as a problem drinker

It seems quite reasonable to expect that students who
report frequent negative consequences or a consistent pattern
of problems resulting from their own drinking during
the academic year would also be quite likely to identify
themselves as having a drinking problem. Yet in an earlier
review of research on problem drinking among college students,
Berkowitz and Perkins (1986) pointed out that the
literature demonstrated only a modest overlap at best between
self-identified prevalence of problem drinking and
rates of excessive consumption and negative consequences.
The more recent research exploring this notion, albeit very
limited, similarly does not provide evidence of a strong
connection. For example, in Presley et al. (1996), the negative
consequence rate for heavy episodic drinkers was
greater than 40% on nine items ranging from performing
poorly on a test (41%) to driving while intoxicated (57%)
to nausea and vomiting (74%), and yet only 22% of these
high-risk drinkers reported thinking at least once during
the year that they might have a drinking or other drug problem.
Posavac (1993) asked a small convenience sample of
133 undergraduate students about whether they thought various
consequences would be indicative of a person having a
drinking problem. Fully two-thirds of the respondents did
not think that throwing up at a party due to drinking was
indicative of a drinking problem if it only happened once a
month. More than half of the students believed that missing
classes or appointments after drinking did not constitute
a problem if limited to only once a month. In the same
study, about half of the males thought becoming sexually
aggressive or promiscuous, getting into a fight or being
unable to remember what happened after drinking, likewise,
was not indicative of a drinking problem if limited to
once a month. Furthermore, one-third of all respondents
did not judge throwing up at a party due to drinking as
indicative of a problem even if it happened more than once
a month.

Need for Further Research in Academic Institutions

Although many studies on negative consequences of student
drinking have been published, systematic assessment
is far from complete. For example, the topics of impaired
athletic performance and the cost of lost educational opportunities
due to drinking have not been thoroughly assessed.
There is little published on the clustering of
consequences by type of consequence or among subgroups
of students. Also, the negative consequence of increased
risk of alcohol dependence in later life due to heavy college
drinking is an important potential consequence to consider.
Conducting empirical studies of this type of
consequence is very difficult, however, given the need for
longitudinal panel data over a significant period of time.
Thus long-term consequences of college drinking remain
largely speculative.

The need for longitudinal data goes beyond the desire to
study long-term effects. Much of the current data linking
the degree of problem behavior to reports about one's usual
level of alcohol consumption are correlational studies. In
this research, it is not at all clear whether some problem
behaviors are a product of the drinking lifestyle of students
or simply a covariate where both drinking and the problem
behavior reflect other influences in one's social background.
Current research on the association between grade point
average and drinking presents an important example of this
dilemma.

Alcohol-related highway crashes most certainly produce
consequences for persons other than the drinking driver in
many instances. Given the level of impaired driving noted
by students in research cited earlier, it is likely that significant
harm to self and others may result.

There can be little doubt that the cumulative individual
damage to self and others as cited in this review produces
a substantial demand on the resources of institutions where
student alcohol misuse is relatively pervasive. Extra time
required in police work, counseling, hospital services, custodial
services and legal counsel, as well as in administrative
“damage control” in public relations, seems apparent.

In short, an extensive accumulation of research on college
drinking has led to a much clearer picture of the problems
produced by student alcohol misuse. Yet more research
on variation and concentration of consequences within college
populations, longitudinal studies of student developmental
behavior and studies of student perspectives on what
are experienced as negative consequences are all needed to
portray more accurately the actual and perceptual landscape
of drinking consequences in college.

Research Implications for Prevention

Although the picture is not complete, researchers surveying
heavy drinking in college populations have demonstrated
a wide range of negative consequences that
personally affect the drinkers themselves, others with whom
they come in contact and the institutions they attend. The
prevalence rates for most negative effects on oneself and
negative effects on others show that, for most of these consequences,
at least 10% of students and frequently as much
as one-third of the population are negatively affected in a
given year. Moreover, there is no evidence that prevalence
rates for most consequences are declining nationally. Thus
the problems generated by student misuse of alcohol continue
to present a major health hazard and social problem
for higher education communities and for society at large.

Amid this assessment it is also important, however, to
emphasize that these consequences are not occurring for
the majority of students in most contexts and that this review
should not be interpreted as an indictment against
students in general. When the majority of students are
misperceived among peers as more problematic than is the
case and when students and staff think the majority of students
carelessly let drinking hurt themselves and others—
misperceptions of the norms that widely occur in most
college populations (Perkins et al., 1999)—then these
misperceptions will facilitate or give social license to the
students who are problematic and destructive in the misuse
of alcohol (Perkins 1997; Perkins and Berkowitz, 1986;
Perkins and Wechsler, 1996). Thus prevention planners must
simultaneously keep in mind and publicly promote to students
the fact that the majority of students are typically not
problematic with regard to drinking.

Furthermore, the effectiveness of traditional prevention
strategies that simply rely on warnings about harm to oneself
must be questioned when used in attempts to reduce
types of consequences found to be relatively pervasive in
student populations and for types of consequences that are
just as likely to occur multiple times as to occur only once
for the individual during the academic year. These findings
suggest that such consequences may not be experienced or
perceived as particularly negative by students reporting them
even though academic staff and prevention specialists may
view the consequences as negative. Otherwise, frequent or
repeated occurrence of particular consequences would be
discouraged once students had experienced the consequence.
Indeed, there is only a modest overlap between selfidentified
problem drinking and the incidence of objectively
defined negative consequences. Thus simply making students
more aware of drinking hazards that they do not perceive
or subjectively experience as indicative of a problem,
or simply attempting to scare students with reports of problem
rates, is not likely to be an effective prevention
approach.

Thinking that consequences to oneself will “teach a lesson”
must be questioned, not only by the fact that multiple
instances of some drinking consequences occur during the
academic year for a significant minority of students, but
also by the fact that, for most types of consequences, the
evidence does not suggest a notable decline in rates from
one year to the next as students progress through the college
years. An intoxicated student who behaves obnoxiously
in public may feel no embarrassment or condemnation at
all if the student's peers complacently ignore him or her or
if both this student and the student's peers simply think of
the student's actions as typical of most students. A student
who vomits during participation in a drinking game may
experience the physical discomfort as only a relatively minor
negative side effect of his or her drinking when weighed
against his or her erroneous notion that this type of activity
is common among almost all students and his or her actual
experience of immediate peer approval in the cheers of other
participants.

Furthermore, many consequences identified in this review
do not directly affect the student who produces them.
Indeed, the lists of consequences to others and to institutions
from students' drinking are equally problematic, and
these consequences often occur without any immediate negative
result for the student who is misusing alcohol. Thus
prevention approaches are needed that enlist faculty, staff
and, most importantly, the majority of students in reacting
negatively and in a clear and direct fashion to students who
do misuse alcohol and in communicating not only the acceptability
but also the normality of healthy student behavior,
so that negative consequences of drinking are not
inadvertently enabled or rewarded in academic communities.
The extensive and tragic list of consequences due to
persistent student alcohol misuse makes clear the stake all
higher education community members have in conveying
this message.

Perkins, H.W. and Berkowitz, A.D. Perceiving the community norms of alcohol
use among students: Some research implications for campus alcohol education
programming. Int. J. Addict. 21: 961-976, 1986.

Perkins, H.W., Meilman, P.W., Leichliter, J.S., Cashin, J.R. and Presley, C.A.
Misperceptions of the norms for the frequency of alcohol and other drug use
on college campuses. J. Amer. Coll. Hlth 47: 253-258, 1999.

Wechsler, H., Dowdall, G.W., Maenner, G., Gledhill-Hoyt, J. and Lee, H. Changes
in binge drinking and related problems among American college students between
1993 and 1997. Results of the Harvard School of Public Health College Alcohol
Survey. J. Amer. Coll. Hlth 47: 57- 68, 1998.